Antimicrobial therapy for chronic bacterial prostatitis (Review) Perletti G, Marras E, Wagenlehner FME, Magri V This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2013, Issue 8 http://www.thecochranelibrary.com Antimicrobial therapy for chronic bacterial prostatitis (Review) Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Antimicrobial therapy for chronic bacterial prostatitis (Review)
Jan 03, 2023
Chronic bacterial prostatitis (CBP) is frequently diagnosed in men of fertile age, and is characterized by a disabling array of symptoms,
including pain in the pelvic area (for example, perineum, testicles), voiding symptoms (increased frequency and urgency, also at night;
pain or discomfort at micturition), and sexual dysfunction. Cure of CBP can be attempted by long-term therapy with antibacterial
agents, but relapses are frequent. Few antibacterial agents are able to distribute to the prostatic tissue and achieve sufficient concentrations
at the site of infection. These agents include fluoroquinolones, macrolides, tetracyclines and trimethoprim. After the introduction of
fluoroquinolones into clinical practice, a number of studies have been performed to optimize the antimicrobial treatment of CBP, and
to improve eradication rates and symptom relief.
Welcome message from author
This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2013, Issue 8
Transcript
Antimicrobial therapy for chronic bacterial prostatitis(Review)
Perletti G, Marras E, Wagenlehner FME, Magri V
This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2013, Issue 8
http://www.thecochranelibrary.com
Antimicrobial therapy for chronic bacterial prostatitis (Review)
Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
1HEADER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2PLAIN LANGUAGE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3SUMMARY OF FINDINGS FOR THE MAIN COMPARISON . . . . . . . . . . . . . . . . . . . 5BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Figure 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Figure 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Figure 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
20ADDITIONAL SUMMARY OF FINDINGS . . . . . . . . . . . . . . . . . . . . . . . . . . 27DISCUSSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29AUTHORS’ CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35CHARACTERISTICS OF STUDIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64DATA AND ANALYSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 1.1. Comparison 1 Different fluoroquinolones: levofloxacin versus ciprofloxacin, Outcome 1 Microbiological efficacy - pathogen eradication (fixed-effect model). . . . . . . . . . . . . . . . . . . . . . 76
Analysis 1.2. Comparison 1 Different fluoroquinolones: levofloxacin versus ciprofloxacin, Outcome 2 Microbiological efficacy - pathogen eradication (random-effects model). . . . . . . . . . . . . . . . . . . . 76
Analysis 1.3. Comparison 1 Different fluoroquinolones: levofloxacin versus ciprofloxacin, Outcome 3 Clinical efficacy. 77 Analysis 1.4. Comparison 1 Different fluoroquinolones: levofloxacin versus ciprofloxacin, Outcome 4 Adverse effects of
treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Analysis 2.1. Comparison 2 Different fluoroquinolones: prulifloxacin versus levofloxacin, Outcome 1 Microbiological
efficacy - pathogen eradication. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Analysis 2.2. Comparison 2 Different fluoroquinolones: prulifloxacin versus levofloxacin, Outcome 2 Clinical efficacy -
NIH-CPSI total score at the end of treatment. . . . . . . . . . . . . . . . . . . . . . . 81 Analysis 2.3. Comparison 2 Different fluoroquinolones: prulifloxacin versus levofloxacin, Outcome 3 Adverse effects of
treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Analysis 3.1. Comparison 3 Different fluoroquinolones: lomefloxacin versus ofloxacin, Outcome 1 Microbiological efficacy
- pathogen eradication at follow-up (6 months). . . . . . . . . . . . . . . . . . . . . . . 83 Analysis 3.2. Comparison 3 Different fluoroquinolones: lomefloxacin versus ofloxacin, Outcome 2 Adverse effects of
treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 Analysis 4.1. Comparison 4 Different fluoroquinolones: lomefloxacin versus ciprofloxacin, Outcome 1 Microbiological
efficacy (intention-to-treat analysis). . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Analysis 4.2. Comparison 4 Different fluoroquinolones: lomefloxacin versus ciprofloxacin, Outcome 2 Microbiological
efficacy (per-protocol analysis). . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Analysis 4.3. Comparison 4 Different fluoroquinolones: lomefloxacin versus ciprofloxacin, Outcome 3 Clinical efficacy
(intention-to-treat analysis). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Analysis 4.4. Comparison 4 Different fluoroquinolones: lomefloxacin versus ciprofloxacin, Outcome 4 Clinical efficacy
(per-protocol analysis). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 Analysis 4.5. Comparison 4 Different fluoroquinolones: lomefloxacin versus ciprofloxacin, Outcome 5 Adverse effects of
treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Analysis 5.1. Comparison 5 Different fluoroquinolones: lomefloxacin versus comparator fluoroquinolone, Outcome 1
Microbiological efficacy - pathogen eradication at follow-up (6 months). . . . . . . . . . . . . . 91 Analysis 5.2. Comparison 5 Different fluoroquinolones: lomefloxacin versus comparator fluoroquinolone, Outcome 2
Adverse effects of treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Analysis 6.1. Comparison 6 Different fluoroquinolones: ciprofloxacin versus comparator fluoroquinolone, Outcome 1
Microbiological efficacy - pathogen eradication at the end of treatment (fixed-effect model). . . . . . . . 93
iAntimicrobial therapy for chronic bacterial prostatitis (Review)
Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Analysis 6.2. Comparison 6 Different fluoroquinolones: ciprofloxacin versus comparator fluoroquinolone, Outcome 2 Microbiological efficacy - pathogen eradication at the end of treatment (random-effects model). . . . . . 94
Analysis 6.3. Comparison 6 Different fluoroquinolones: ciprofloxacin versus comparator fluoroquinolone, Outcome 3 Clinical efficacy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Analysis 6.4. Comparison 6 Different fluoroquinolones: ciprofloxacin versus comparator fluoroquinolone, Outcome 4 Adverse effects of treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Analysis 7.1. Comparison 7 Different fluoroquinolones: levofloxacin versus comparator fluoroquinolone, Outcome 1 Microbiological efficacy - pathogen eradication (fixed-effect model). . . . . . . . . . . . . . . . 98
Analysis 7.2. Comparison 7 Different fluoroquinolones: levofloxacin versus comparator fluoroquinolone, Outcome 2 Microbiological efficacy - pathogen eradication (random-effects model). . . . . . . . . . . . . . . 99
Analysis 7.3. Comparison 7 Different fluoroquinolones: levofloxacin versus comparator fluoroquinolone, Outcome 3 Adverse effects of treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Analysis 8.1. Comparison 8 Fluoroquinolone versus other antibacterial agent: prulifloxacin versus doxycycline in chlamydial prostatitis, Outcome 1 Microbiological efficacy - absence of Chlamydia trachomatis DNA and IgA at the end of treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Analysis 8.2. Comparison 8 Fluoroquinolone versus other antibacterial agent: prulifloxacin versus doxycycline in chlamydial prostatitis, Outcome 2 Clinical efficacy - NIH-CPSI total score at the end of treatment. . . . . . . . . 102
Analysis 8.3. Comparison 8 Fluoroquinolone versus other antibacterial agent: prulifloxacin versus doxycycline in chlamydial prostatitis, Outcome 3 Clinical efficacy - number of asymptomatic participants at the end of therapy. . . . 102
Analysis 8.4. Comparison 8 Fluoroquinolone versus other antibacterial agent: prulifloxacin versus doxycycline in chlamydial prostatitis, Outcome 4 Adverse effects of treatment. . . . . . . . . . . . . . . . . . . . . . 103
Analysis 9.1. Comparison 9 Fluoroquinolone versus other antibacterial agent: ofloxacin versus minocycline in ureaplasmal prostatitis, Outcome 1 Microbiological efficacy - pathogen eradication. . . . . . . . . . . . . . . 104
Analysis 9.2. Comparison 9 Fluoroquinolone versus other antibacterial agent: ofloxacin versus minocycline in ureaplasmal prostatitis, Outcome 2 Clinical efficacy (cure or improvement) at the end of treatment. . . . . . . . . 104
Analysis 10.1. Comparison 10 Fluoroquinolone versus other antibacterial agent: ofloxacin versus carbenicillin, Outcome 1 Microbiological efficacy - pathogen eradication. . . . . . . . . . . . . . . . . . . . . . . 105
Analysis 10.2. Comparison 10 Fluoroquinolone versus other antibacterial agent: ofloxacin versus carbenicillin, Outcome 2 Clinical efficacy (cure or improvement) at the end of treatment. . . . . . . . . . . . . . . . . 105
Analysis 10.3. Comparison 10 Fluoroquinolone versus other antibacterial agent: ofloxacin versus carbenicillin, Outcome 3 Adverse effects of treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Analysis 11.1. Comparison 11 Fluoroquinolone versus other antibacterial agent: lomefloxacin versus co-trimoxazole, Outcome 1 Microbiological efficacy. . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Analysis 11.2. Comparison 11 Fluoroquinolone versus other antibacterial agent: lomefloxacin versus co-trimoxazole, Outcome 2 Clinical efficacy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Analysis 11.3. Comparison 11 Fluoroquinolone versus other antibacterial agent: lomefloxacin versus co-trimoxazole, Outcome 3 Adverse effects of treatment. . . . . . . . . . . . . . . . . . . . . . . . . 109
Analysis 12.1. Comparison 12 Fluoroquinolone versus other antibacterial agent: ciprofloxacin versus azithromycin in chlamydial prostatitis, Outcome 1 Microbiological efficacy (pathogen eradication) at the end of treatment. . . 110
Analysis 12.2. Comparison 12 Fluoroquinolone versus other antibacterial agent: ciprofloxacin versus azithromycin in chlamydial prostatitis, Outcome 2 Clinical efficacy (cure or improvement) at the end of treatment. . . . . 110
Analysis 12.3. Comparison 12 Fluoroquinolone versus other antibacterial agent: ciprofloxacin versus azithromycin in chlamydial prostatitis, Outcome 3 Adverse effects of treatment. . . . . . . . . . . . . . . . . . 111
Analysis 13.1. Comparison 13 Non-fluoroquinolone antibacterial agents: minocycline versus cephalexin, Outcome 1 Microbiological efficacy (pathogen eradication and eradication plus superinfection) at the end of treatment. . 112
Analysis 13.2. Comparison 13 Non-fluoroquinolone antibacterial agents: minocycline versus cephalexin, Outcome 2 Clinical efficacy (cure or improvement) at the end of treatment. . . . . . . . . . . . . . . . . 112
Analysis 13.3. Comparison 13 Non-fluoroquinolone antibacterial agents: minocycline versus cephalexin, Outcome 3 Microbiological recurrence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Analysis 14.1. Comparison 14 Non-fluoroquinolone antibacterial agents: azithromycin versus clarithromycin in chlamydial prostatitis, Outcome 1 Microbiological efficacy (pathogen eradication) at the end of treatment. . . . . . . 114
Analysis 14.2. Comparison 14 Non-fluoroquinolone antibacterial agents: azithromycin versus clarithromycin in chlamydial prostatitis, Outcome 2 Clinical efficacy (cure) at the end of treatment. . . . . . . . . . . . . . . 114
iiAntimicrobial therapy for chronic bacterial prostatitis (Review)
Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Analysis 14.3. Comparison 14 Non-fluoroquinolone antibacterial agents: azithromycin versus clarithromycin in chlamydial prostatitis, Outcome 3 Adverse effects of treatment. . . . . . . . . . . . . . . . . . . . . . 115
Analysis 15.1. Comparison 15 Non-fluoroquinolone antibacterial agents: azithromycin versus doxycycline in chlamydial prostatitis, Outcome 1 Microbiological efficacy (pathogen eradication) at the end of treatment. . . . . . . 116
Analysis 15.2. Comparison 15 Non-fluoroquinolone antibacterial agents: azithromycin versus doxycycline in chlamydial prostatitis, Outcome 2 Clinical efficacy. . . . . . . . . . . . . . . . . . . . . . . . . . 117
Analysis 15.3. Comparison 15 Non-fluoroquinolone antibacterial agents: azithromycin versus doxycycline in chlamydial prostatitis, Outcome 3 Adverse effects of treatment. . . . . . . . . . . . . . . . . . . . . . 118
Analysis 16.1. Comparison 16 Non-fluoroquinolone antibacterial agents: azithromycin versus doxycycline in ureaplasmal prostatitis, Outcome 1 Microbiological efficacy (pathogen eradication) at the end of treatment. . . . . . . 119
Analysis 16.2. Comparison 16 Non-fluoroquinolone antibacterial agents: azithromycin versus doxycycline in ureaplasmal prostatitis, Outcome 2 Clinical efficacy (cure) at the end of treatment. . . . . . . . . . . . . . . 119
Analysis 16.3. Comparison 16 Non-fluoroquinolone antibacterial agents: azithromycin versus doxycycline in ureaplasmal prostatitis, Outcome 3 Adverse effects of treatment. . . . . . . . . . . . . . . . . . . . . . 120
Analysis 17.1. Comparison 17 Different dosing regimens: azithromycin 4.5 g versus 6.0 g total doses in chlamydial prostatitis, Outcome 1 Microbiological efficacy (pathogen eradication) at the end of treatment. . . . . . . 121
Analysis 17.2. Comparison 17 Different dosing regimens: azithromycin 4.5 g versus 6.0 g total doses in chlamydial prostatitis, Outcome 2 Clinical efficacy (cure) at the end of therapy. . . . . . . . . . . . . . . . 121
Analysis 17.3. Comparison 17 Different dosing regimens: azithromycin 4.5 g versus 6.0 g total doses in chlamydial prostatitis, Outcome 3 Adverse effects of treatment. . . . . . . . . . . . . . . . . . . . . . 122
Analysis 18.1. Comparison 18 Different therapy duration: co-trimoxazole 480 mg twice daily for 12 weeks versus 10 days, Outcome 1 Microbiological efficacy (pathogen eradication) at the end of treatment. . . . . . . . . . 123
Analysis 18.2. Comparison 18 Different therapy duration: co-trimoxazole 480 mg twice daily for 12 weeks versus 10 days, Outcome 2 Adverse effects of treatment. . . . . . . . . . . . . . . . . . . . . . . . . 124
Analysis 19.1. Comparison 19 Fluoroquinolone combined with phosphodiesterase-5 inhibitor versus fluoroquinolone: levofloxacin plus vardenafil 10 mg/day versus levofloxacin, Outcome 1 Microbiological efficacy (pathogen eradication) at the end of treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Analysis 19.2. Comparison 19 Fluoroquinolone combined with phosphodiesterase-5 inhibitor versus fluoroquinolone: levofloxacin plus vardenafil 10 mg/day versus levofloxacin, Outcome 2 Clinical efficacy - NIH-CPSI score at the end of treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
Analysis 19.3. Comparison 19 Fluoroquinolone combined with phosphodiesterase-5 inhibitor versus fluoroquinolone: levofloxacin plus vardenafil 10 mg/day versus levofloxacin, Outcome 3 Clinical efficacy - number of participants with leukocytosis in post-massage urine specimens at the end of treatment. . . . . . . . . . . . . . . 127
Analysis 19.4. Comparison 19 Fluoroquinolone combined with phosphodiesterase-5 inhibitor versus fluoroquinolone: levofloxacin plus vardenafil 10 mg/day versus levofloxacin, Outcome 4 Clinical efficacy - urine peak flow rate at the end of treatment (mL/s). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Analysis 20.1. Comparison 20 Fluoroquinolone combined with phosphodiesterase-5 inhibitor versus fluoroquinolone: levofloxacin plus vardenafil 10 mg on-demand versus levofloxacin, Outcome 1 Microbiological efficacy (pathogen eradication) at the end of treatment. . . . . . . . . . . . . . . . . . .…
Perletti G, Marras E, Wagenlehner FME, Magri V
This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2013, Issue 8
http://www.thecochranelibrary.com
Antimicrobial therapy for chronic bacterial prostatitis (Review)
Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
1HEADER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2PLAIN LANGUAGE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3SUMMARY OF FINDINGS FOR THE MAIN COMPARISON . . . . . . . . . . . . . . . . . . . 5BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Figure 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Figure 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Figure 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
20ADDITIONAL SUMMARY OF FINDINGS . . . . . . . . . . . . . . . . . . . . . . . . . . 27DISCUSSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29AUTHORS’ CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35CHARACTERISTICS OF STUDIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64DATA AND ANALYSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 1.1. Comparison 1 Different fluoroquinolones: levofloxacin versus ciprofloxacin, Outcome 1 Microbiological efficacy - pathogen eradication (fixed-effect model). . . . . . . . . . . . . . . . . . . . . . 76
Analysis 1.2. Comparison 1 Different fluoroquinolones: levofloxacin versus ciprofloxacin, Outcome 2 Microbiological efficacy - pathogen eradication (random-effects model). . . . . . . . . . . . . . . . . . . . 76
Analysis 1.3. Comparison 1 Different fluoroquinolones: levofloxacin versus ciprofloxacin, Outcome 3 Clinical efficacy. 77 Analysis 1.4. Comparison 1 Different fluoroquinolones: levofloxacin versus ciprofloxacin, Outcome 4 Adverse effects of
treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Analysis 2.1. Comparison 2 Different fluoroquinolones: prulifloxacin versus levofloxacin, Outcome 1 Microbiological
efficacy - pathogen eradication. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Analysis 2.2. Comparison 2 Different fluoroquinolones: prulifloxacin versus levofloxacin, Outcome 2 Clinical efficacy -
NIH-CPSI total score at the end of treatment. . . . . . . . . . . . . . . . . . . . . . . 81 Analysis 2.3. Comparison 2 Different fluoroquinolones: prulifloxacin versus levofloxacin, Outcome 3 Adverse effects of
treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Analysis 3.1. Comparison 3 Different fluoroquinolones: lomefloxacin versus ofloxacin, Outcome 1 Microbiological efficacy
- pathogen eradication at follow-up (6 months). . . . . . . . . . . . . . . . . . . . . . . 83 Analysis 3.2. Comparison 3 Different fluoroquinolones: lomefloxacin versus ofloxacin, Outcome 2 Adverse effects of
treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 Analysis 4.1. Comparison 4 Different fluoroquinolones: lomefloxacin versus ciprofloxacin, Outcome 1 Microbiological
efficacy (intention-to-treat analysis). . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Analysis 4.2. Comparison 4 Different fluoroquinolones: lomefloxacin versus ciprofloxacin, Outcome 2 Microbiological
efficacy (per-protocol analysis). . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Analysis 4.3. Comparison 4 Different fluoroquinolones: lomefloxacin versus ciprofloxacin, Outcome 3 Clinical efficacy
(intention-to-treat analysis). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Analysis 4.4. Comparison 4 Different fluoroquinolones: lomefloxacin versus ciprofloxacin, Outcome 4 Clinical efficacy
(per-protocol analysis). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 Analysis 4.5. Comparison 4 Different fluoroquinolones: lomefloxacin versus ciprofloxacin, Outcome 5 Adverse effects of
treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Analysis 5.1. Comparison 5 Different fluoroquinolones: lomefloxacin versus comparator fluoroquinolone, Outcome 1
Microbiological efficacy - pathogen eradication at follow-up (6 months). . . . . . . . . . . . . . 91 Analysis 5.2. Comparison 5 Different fluoroquinolones: lomefloxacin versus comparator fluoroquinolone, Outcome 2
Adverse effects of treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Analysis 6.1. Comparison 6 Different fluoroquinolones: ciprofloxacin versus comparator fluoroquinolone, Outcome 1
Microbiological efficacy - pathogen eradication at the end of treatment (fixed-effect model). . . . . . . . 93
iAntimicrobial therapy for chronic bacterial prostatitis (Review)
Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Analysis 6.2. Comparison 6 Different fluoroquinolones: ciprofloxacin versus comparator fluoroquinolone, Outcome 2 Microbiological efficacy - pathogen eradication at the end of treatment (random-effects model). . . . . . 94
Analysis 6.3. Comparison 6 Different fluoroquinolones: ciprofloxacin versus comparator fluoroquinolone, Outcome 3 Clinical efficacy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Analysis 6.4. Comparison 6 Different fluoroquinolones: ciprofloxacin versus comparator fluoroquinolone, Outcome 4 Adverse effects of treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Analysis 7.1. Comparison 7 Different fluoroquinolones: levofloxacin versus comparator fluoroquinolone, Outcome 1 Microbiological efficacy - pathogen eradication (fixed-effect model). . . . . . . . . . . . . . . . 98
Analysis 7.2. Comparison 7 Different fluoroquinolones: levofloxacin versus comparator fluoroquinolone, Outcome 2 Microbiological efficacy - pathogen eradication (random-effects model). . . . . . . . . . . . . . . 99
Analysis 7.3. Comparison 7 Different fluoroquinolones: levofloxacin versus comparator fluoroquinolone, Outcome 3 Adverse effects of treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Analysis 8.1. Comparison 8 Fluoroquinolone versus other antibacterial agent: prulifloxacin versus doxycycline in chlamydial prostatitis, Outcome 1 Microbiological efficacy - absence of Chlamydia trachomatis DNA and IgA at the end of treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Analysis 8.2. Comparison 8 Fluoroquinolone versus other antibacterial agent: prulifloxacin versus doxycycline in chlamydial prostatitis, Outcome 2 Clinical efficacy - NIH-CPSI total score at the end of treatment. . . . . . . . . 102
Analysis 8.3. Comparison 8 Fluoroquinolone versus other antibacterial agent: prulifloxacin versus doxycycline in chlamydial prostatitis, Outcome 3 Clinical efficacy - number of asymptomatic participants at the end of therapy. . . . 102
Analysis 8.4. Comparison 8 Fluoroquinolone versus other antibacterial agent: prulifloxacin versus doxycycline in chlamydial prostatitis, Outcome 4 Adverse effects of treatment. . . . . . . . . . . . . . . . . . . . . . 103
Analysis 9.1. Comparison 9 Fluoroquinolone versus other antibacterial agent: ofloxacin versus minocycline in ureaplasmal prostatitis, Outcome 1 Microbiological efficacy - pathogen eradication. . . . . . . . . . . . . . . 104
Analysis 9.2. Comparison 9 Fluoroquinolone versus other antibacterial agent: ofloxacin versus minocycline in ureaplasmal prostatitis, Outcome 2 Clinical efficacy (cure or improvement) at the end of treatment. . . . . . . . . 104
Analysis 10.1. Comparison 10 Fluoroquinolone versus other antibacterial agent: ofloxacin versus carbenicillin, Outcome 1 Microbiological efficacy - pathogen eradication. . . . . . . . . . . . . . . . . . . . . . . 105
Analysis 10.2. Comparison 10 Fluoroquinolone versus other antibacterial agent: ofloxacin versus carbenicillin, Outcome 2 Clinical efficacy (cure or improvement) at the end of treatment. . . . . . . . . . . . . . . . . 105
Analysis 10.3. Comparison 10 Fluoroquinolone versus other antibacterial agent: ofloxacin versus carbenicillin, Outcome 3 Adverse effects of treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Analysis 11.1. Comparison 11 Fluoroquinolone versus other antibacterial agent: lomefloxacin versus co-trimoxazole, Outcome 1 Microbiological efficacy. . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Analysis 11.2. Comparison 11 Fluoroquinolone versus other antibacterial agent: lomefloxacin versus co-trimoxazole, Outcome 2 Clinical efficacy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Analysis 11.3. Comparison 11 Fluoroquinolone versus other antibacterial agent: lomefloxacin versus co-trimoxazole, Outcome 3 Adverse effects of treatment. . . . . . . . . . . . . . . . . . . . . . . . . 109
Analysis 12.1. Comparison 12 Fluoroquinolone versus other antibacterial agent: ciprofloxacin versus azithromycin in chlamydial prostatitis, Outcome 1 Microbiological efficacy (pathogen eradication) at the end of treatment. . . 110
Analysis 12.2. Comparison 12 Fluoroquinolone versus other antibacterial agent: ciprofloxacin versus azithromycin in chlamydial prostatitis, Outcome 2 Clinical efficacy (cure or improvement) at the end of treatment. . . . . 110
Analysis 12.3. Comparison 12 Fluoroquinolone versus other antibacterial agent: ciprofloxacin versus azithromycin in chlamydial prostatitis, Outcome 3 Adverse effects of treatment. . . . . . . . . . . . . . . . . . 111
Analysis 13.1. Comparison 13 Non-fluoroquinolone antibacterial agents: minocycline versus cephalexin, Outcome 1 Microbiological efficacy (pathogen eradication and eradication plus superinfection) at the end of treatment. . 112
Analysis 13.2. Comparison 13 Non-fluoroquinolone antibacterial agents: minocycline versus cephalexin, Outcome 2 Clinical efficacy (cure or improvement) at the end of treatment. . . . . . . . . . . . . . . . . 112
Analysis 13.3. Comparison 13 Non-fluoroquinolone antibacterial agents: minocycline versus cephalexin, Outcome 3 Microbiological recurrence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Analysis 14.1. Comparison 14 Non-fluoroquinolone antibacterial agents: azithromycin versus clarithromycin in chlamydial prostatitis, Outcome 1 Microbiological efficacy (pathogen eradication) at the end of treatment. . . . . . . 114
Analysis 14.2. Comparison 14 Non-fluoroquinolone antibacterial agents: azithromycin versus clarithromycin in chlamydial prostatitis, Outcome 2 Clinical efficacy (cure) at the end of treatment. . . . . . . . . . . . . . . 114
iiAntimicrobial therapy for chronic bacterial prostatitis (Review)
Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Analysis 14.3. Comparison 14 Non-fluoroquinolone antibacterial agents: azithromycin versus clarithromycin in chlamydial prostatitis, Outcome 3 Adverse effects of treatment. . . . . . . . . . . . . . . . . . . . . . 115
Analysis 15.1. Comparison 15 Non-fluoroquinolone antibacterial agents: azithromycin versus doxycycline in chlamydial prostatitis, Outcome 1 Microbiological efficacy (pathogen eradication) at the end of treatment. . . . . . . 116
Analysis 15.2. Comparison 15 Non-fluoroquinolone antibacterial agents: azithromycin versus doxycycline in chlamydial prostatitis, Outcome 2 Clinical efficacy. . . . . . . . . . . . . . . . . . . . . . . . . . 117
Analysis 15.3. Comparison 15 Non-fluoroquinolone antibacterial agents: azithromycin versus doxycycline in chlamydial prostatitis, Outcome 3 Adverse effects of treatment. . . . . . . . . . . . . . . . . . . . . . 118
Analysis 16.1. Comparison 16 Non-fluoroquinolone antibacterial agents: azithromycin versus doxycycline in ureaplasmal prostatitis, Outcome 1 Microbiological efficacy (pathogen eradication) at the end of treatment. . . . . . . 119
Analysis 16.2. Comparison 16 Non-fluoroquinolone antibacterial agents: azithromycin versus doxycycline in ureaplasmal prostatitis, Outcome 2 Clinical efficacy (cure) at the end of treatment. . . . . . . . . . . . . . . 119
Analysis 16.3. Comparison 16 Non-fluoroquinolone antibacterial agents: azithromycin versus doxycycline in ureaplasmal prostatitis, Outcome 3 Adverse effects of treatment. . . . . . . . . . . . . . . . . . . . . . 120
Analysis 17.1. Comparison 17 Different dosing regimens: azithromycin 4.5 g versus 6.0 g total doses in chlamydial prostatitis, Outcome 1 Microbiological efficacy (pathogen eradication) at the end of treatment. . . . . . . 121
Analysis 17.2. Comparison 17 Different dosing regimens: azithromycin 4.5 g versus 6.0 g total doses in chlamydial prostatitis, Outcome 2 Clinical efficacy (cure) at the end of therapy. . . . . . . . . . . . . . . . 121
Analysis 17.3. Comparison 17 Different dosing regimens: azithromycin 4.5 g versus 6.0 g total doses in chlamydial prostatitis, Outcome 3 Adverse effects of treatment. . . . . . . . . . . . . . . . . . . . . . 122
Analysis 18.1. Comparison 18 Different therapy duration: co-trimoxazole 480 mg twice daily for 12 weeks versus 10 days, Outcome 1 Microbiological efficacy (pathogen eradication) at the end of treatment. . . . . . . . . . 123
Analysis 18.2. Comparison 18 Different therapy duration: co-trimoxazole 480 mg twice daily for 12 weeks versus 10 days, Outcome 2 Adverse effects of treatment. . . . . . . . . . . . . . . . . . . . . . . . . 124
Analysis 19.1. Comparison 19 Fluoroquinolone combined with phosphodiesterase-5 inhibitor versus fluoroquinolone: levofloxacin plus vardenafil 10 mg/day versus levofloxacin, Outcome 1 Microbiological efficacy (pathogen eradication) at the end of treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Analysis 19.2. Comparison 19 Fluoroquinolone combined with phosphodiesterase-5 inhibitor versus fluoroquinolone: levofloxacin plus vardenafil 10 mg/day versus levofloxacin, Outcome 2 Clinical efficacy - NIH-CPSI score at the end of treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
Analysis 19.3. Comparison 19 Fluoroquinolone combined with phosphodiesterase-5 inhibitor versus fluoroquinolone: levofloxacin plus vardenafil 10 mg/day versus levofloxacin, Outcome 3 Clinical efficacy - number of participants with leukocytosis in post-massage urine specimens at the end of treatment. . . . . . . . . . . . . . . 127
Analysis 19.4. Comparison 19 Fluoroquinolone combined with phosphodiesterase-5 inhibitor versus fluoroquinolone: levofloxacin plus vardenafil 10 mg/day versus levofloxacin, Outcome 4 Clinical efficacy - urine peak flow rate at the end of treatment (mL/s). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Analysis 20.1. Comparison 20 Fluoroquinolone combined with phosphodiesterase-5 inhibitor versus fluoroquinolone: levofloxacin plus vardenafil 10 mg on-demand versus levofloxacin, Outcome 1 Microbiological efficacy (pathogen eradication) at the end of treatment. . . . . . . . . . . . . . . . . . .…
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